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PROGRAMS & COACHING
Blog
About
Podcast
Please let us know about the current status of your effected area
*
Indicates required field
Name
*
First
Last
Email
*
During the past week, for how many days have you experienced pain in the effected area?
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0
1
2
3
4
5
6
7
On a scale of 0 (no pain) to 10 (severe pain), when you experience the pain, how bad has it been?
*
0 (no pain)
1
2
3
4
5
6
7
8
9
10 (severe pain)
To what extent does avoiding activities due to a fear of aggravating the effected area impact your quality of life?
*
Not at all
A little
A fair amount
A lot
An extreme amount
During what type of activities do you experience pain from the effected area? (tick all that apply)
*
Inactive (sitting, standing or laying down)
Walking
Getting in and out of a seated position
Picking up and moving objects
Moderate activity or exercise (jogging, hiking, cycling, swimming)
Strenuous activity or exercise (BJJ, lifting weights, playing other sports)
On average, over the past month, how many days per week have you missed Jiu Jitsu training because of the pain?
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None
Some
Most
All
Submit